ICD-10 Training: Start with a plan

Even though the International Classification of Diseases-10th Revision-Clinical Management (ICD-10-CM) has been delayed until October 2015, your practice can still take steps toward implementing the coding system at a pace that can benefit your staff. This series aims to help your practice prepare. Start by developing a project plan that includes understanding the coding changes, plan for payment delays and team training, and then assemble your team to start gathering resources and information.

One overlooked resource to prepare for ICD-10-CM is the Centers for Medicare and Medicaid Services (CMS) website.

For providers who still don’t have a clear understanding of how ICD-10-CM will affect their practices, the CMS website is probably the most accessible source of information. CMS resources include everything from the statute and regulations, to downloadable code sets, to provider-specific planning and implementation resources. There are links to videos, webinars, and web-based tools that provide guidance on transitioning to ICD-10-CM. Anyone who has not yet accessed the CMS website for ICD-10 information might want to start by checking out the “Latest News.”

This page includes a link to the online resource called “Road to 10.” That website was developed by CMS with the help of providers in small practices and includes specialty specific tools designed to help build a practice-specific ICD-10-CM action plan. The “Road to 10” site provides information on the following:

• ICD-10-CM basics

• What is different about ICD-10-CM?

• Practice benefits

• Frequently asked questions

• Quick references

• Template library

• Events

• Building an action plan

ICD-10-CM basics
For providers who are not yet familiar with ICD-10-CM, the ICD-10 Basics page provides an overview of the ICD-10-CM code structure and a summary of ICD-10-CM chapters with an estimated count of the number of codes in each chapter.

ICD-10 Basics also discusses the need to assign codes based on the documentation using the ICD-10-CM reference (coding book or software), which is referred to as “native coding,” rather than attempting to assign codes using ICD-9-CM to ICD-10-CM crosswalks or mappers.

Mappers and crosswalks are good resources for familiarizing providers with the differences between ICD-9-CM and ICD-10-CM; however, they should not be used as the sole source for code assignment.

Understanding the differences
ICD-10-CM is not an update of ICD-9-CM. The structure of ICD-10-CM was first developed with the input of a select group of physicians and then further refined by physician specialty groups.

Specialty groups requested additional detail for many codes to help capture diagnostic details that physicians use to determine and deliver the most appropriate patient care.

Practice benefit
CMS breaks the benefits of ICD-10-CM implementation into four categories: clinical, operational, professional, and financial.
Some of the clinical benefits identified by CMS include:

• Enhanced ability of physicians to make clinical decisions with the more specific diagnostic data contained in ICD-10-CM codes,

• New insights into patients and the clinical care they receive due to the ability to capture more specific information regarding diseases and disease processes with ICD-10-CM codes,

• Better tracking of the course of an illness or disease process because ICD-10-CM codes capture severity, and

• More detailed data elements in ICD-10-CM codes to facilitate research, clinical trials, and epidemiological studies

Operational benefits include:

• Ability to match professional resources with patient needs due to more precise definitions of patient conditions found in ICD-10-CM codes,

• Better communication between healthcare providers because ICD-10-CM codes capture more specific information about patient conditions, and

• Data captured with ICD-10-CM codes enhances providers’ ability to determine staffing and medical technology needs

Professional benefits include:

• ICD-10-CM code specificity provides objective data to support credentialing and privilege requirements,

• ICD-10-CM codes provide more specificity for development and reporting of quality measures, and

• ICD-10-CM codes provide better data to support public health initiatives

Financial benefits include:

• ICD-10-CM codes require better documentation of clinical conditions, which in turn helps to support the medical necessity and level of care for the services provided, and

• Use of the codes may reduce audit risks due to the greater specificity of ICD-10-CM codes

Frequently asked questions
The FAQ section provides answers to a variety of questions, addressing:

• The definition of ICD-10-CM compliance,

• ICD-10-CM compliance deadlines,

• transitioning to ICD-10-CM,

• training of staff,

• testing of coding and billing systems, and

• vendor and payer responsibilities

Quick references
The quick references section is one the most valuable sections on the “Road to 10” web page. It provides links to all the resources and educational material that CMS has compiled related to ICD-10-CM.

You will find everything from general information on ICD-10-CM, to documentation requirements, to ICD-10-CM code sets and general equivalency mappings, to implementation plans for physician practices.

Templates
CMS has developed five templates for use as part of the practice’s action plan for ICD-10-CM implementation and compliance. Available templates include:

• process and system inventory,

• technology vendor assessment,

• billing service assessment,

• clearinghouse assessment, and

• payer assessment

Events
The events section provides a calendar that lists upcoming CMS events related to ICD-10-CM.

For example, in March CMS has ICD-10-CM testing scheduled for the first week of March, committee meetings, and ICD-10-CM webinars.

Build your action plan
This tab helps practices develop an action plan based on specific characteristics of the practice. The first five components to building an action plan include:

• physician specialty

• practice size

• vendors (EHR, practice management system, billing service, clearinghouse)

• payers (commercial, Medicare, Medicaid, military)

• ICD-10 readiness (planning, assessment, implementation, testing)

Once each of the characteristics has been defined, the user is able to click on “Build Your Action Plan” and a detailed, downloadable action plan is then provided.

The place to start
The “Road to 10” web pages are a great place for small and medium sized practices to start or continue the process of preparing for ICD-10-CM compliance.

Once an action plan is developed, physician practices will have a better idea of what additional resources are needed, such as ICD-10-CM books and/or coding software, refresher anatomy and physiology courses for coding and billing staff, and documentation analysis tools.